Provider Demographics
NPI:1447910963
Name:PECHECK, MICHELLE LISA (RDN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LISA
Last Name:PECHECK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 PONCE AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1510
Mailing Address - Country:US
Mailing Address - Phone:714-469-3708
Mailing Address - Fax:714-993-4041
Practice Address - Street 1:408 PONCE AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-1510
Practice Address - Country:US
Practice Address - Phone:714-469-3708
Practice Address - Fax:714-993-4041
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86016896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered